The decline of clinical skills: a challenge for medical schools

Faustinella, Fabrizia; Jacobs, Robin J.

doi:10.5116/ijme.5b3f.9fb3

Cited by 51 publications

(47 citation statements)

References 25 publications

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“…This coupled with a lack of a formal supervision process for clinical examination skill learning, such as a log book is anecdotally associated with decreased clinical skill confidence in students. Other reasons include an often reported decline in the clinical skills of medical students and residents and a lack of acknowledgement of their importance by students [24]. Although frequency of performing examinations is insufficient to assess performance, our study nonetheless provides a simple gauge for medical schools to assess if teaching is providing sufficient exposure or not.…”

Section: Discussionmentioning

confidence: 94%

The influence of gender on clinical examination skills of medical students in Jordan: a cross-sectional study

et al. 2020

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Background: A graduating medical doctor is expected to be competent in physical examinations across all systems. The exploration of how gender affects the development of clinical skills has not been explored in an Arab context, despite cultural restrictions that make it more difficult for students and doctors to examine the opposite sex. Methods: A cross sectional survey was undertaken of graduating final year medical students in Northern Jordan. We asked about students' perceptions regarding factors that may impact the development of clinical skills potentially related to gender, and asked about the frequency of examinations performed during their training for intimate and general physical examinations on all patients, as well as patients of the opposite sex. We also asked about the students' confidence in performing the examinations (3-point Likert-scale). Comparison of male and female proportions was done using Chi square tests analysis. Results: One hundred eighty-eight final year students from 481 students (41%) completed the survey, 99 males and 89 females. The greatest factor given for impacting a student's clinical examination of a patient of the opposite sex was cultural or religious traditions. Overall male students perform more clinical examinations than female students, with the odds of a male conducting more than 10 cardiovascular examinations on any patient compared to female students being 2.07 (1.13-3.79) and as high as 3.06 (1.53-6.18) for thyroid examinations. However, females were significantly more likely to examine male patients than vice versa (0.49 (0.27-0.88) for cardiovascular and 0.39 (0.21-0.71) for respiratory examinations). The gender division was more prominent for intimate examinations, with a lower odds of males conducting breast 0.11 (0.04-0.28) and vaginal examinations 0.22 (0.02-1.98) and more male students conducting prostate examinations OR 11.00 (1.39-87.03) and male genitalia examinations OR 16.31 (3.75-70.94). Overall a large proportion of students had never performed common intimate clinical examinations at all. Conclusions: In our context, clinical exposure to both intimate and general clinical examinations differs significantly between male and female students. A greater awareness and more research on the influence of gender on clinical skill attainment in conservative cultures is needed with appropriate adaption of clinical teaching. Trial registration: Non interventional thus not required.

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Section: Discussionmentioning

confidence: 94%

The influence of gender on clinical examination skills of medical students in Jordan: a cross-sectional study

et al. 2020

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“…The results showed that 90.1% of outpatients owned mobile phones, 55.3% of patients used smart phones, and 38.5% of patients (69.5% of smart phone owners) used mHealth [16]. Among all patients in this study, 35.5% sought health information from their smart phones, 22.0% accessed an mHealth app, and 20.8% tracked or managed health conditions via mobile devices [16]. Another study presented a new approach in which primary care practitioners prescribed mHealth apps to their patients and discussed the health data collected from the apps in subsequent patient visits [17].…”

mentioning

confidence: 69%

“…Although the findings revealed that mHealth apps were able to perform some GP tasks, it could not be concluded that mHealth apps could replace GPs. Being a medical doctor requires integrative skills, art, values, and ethics [35,36]. For example, taking history without physical examination may lead to unnecessary investigations and a misdiagnosis.…”

Section: Discussionmentioning

confidence: 99%

Can mobile health apps replace GPs? A scoping review of comparisons between mobile apps and GP tasks

Wattanapisit

Teo

Wattanapisit

et al. 2020

BMC Med Inform Decis Mak

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Background: Mobile health applications (mHealth apps) are increasingly being used to perform tasks that are conventionally performed by general practitioners (GPs), such as those involved in promoting health, preventing disease, diagnosis, treatment, monitoring, and support for health services. This raises an important question: can mobile apps replace GPs? This study aimed to systematically search for and identify mobile apps that can perform GP tasks. Methods: A scoping review was carried out. The Google Play Store and Apple App Store were searched for mobile apps, using search terms derived from the UK Royal College of General Practitioners (RCGP) guideline on GPs' core capabilities and competencies. A manual search was also performed to identify additional apps. Results: The final analysis included 17 apps from the Google Play Store and Apple App Store, and 21 apps identified by the manual search. mHealth apps were found to have the potential to replace GPs for tasks such as recording medical history and making diagnoses; performing some physical examinations; supporting clinical decision making and management; assisting in urgent, long-term, and disease-specific care; and health promotion. In contrast, mHealth apps were unable to perform medical procedures, appropriately utilise other professionals, and coordinate a teambased approach. Conclusions: This scoping review highlights the functions of mHealth apps that can potentially replace GP tasks. Future research should focus on assessing the performance and quality of mHealth apps in comparison with that of real doctors.

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“…While students cannot participate in the clinical examination component of the patient interaction during live‐streamed ward rounds, they can hear the relevant history taking. Evidence indicates that physicians can collect 60–80% of the information relevant for a diagnosis just by taking a medical history, leading to a final diagnosis in more than 70% of cases …”

Section: Phase 3: Student Remote Case‐based Ward Round Presentation (mentioning

confidence: 99%

Live‐streamed ward rounds: a tool for clinical teaching during the COVID ‐19 pandemic

Pennell

Kluckow

Chen

et al. 2020

Medical Journal of Australia

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The decline of clinical skills: a challenge for medical schools

Cited by 51 publications

References 25 publications

The influence of gender on clinical examination skills of medical students in Jordan: a cross-sectional study

The influence of gender on clinical examination skills of medical students in Jordan: a cross-sectional study

Can mobile health apps replace GPs? A scoping review of comparisons between mobile apps and GP tasks

Live‐streamed ward rounds: a tool for clinical teaching during the COVID ‐19 pandemic

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